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�� � 3� ' <br /> Date ��/ / FnNic Works Pi..mP� � —- . <br /> ApniiC?�1Cn Fof �in� DeOt• <br /> �'UBLIC W0�3hS �ERMI� P°°��°W°��qF�° --- <br /> ,o�r�F�e s __ <br /> less/+nnt Fa,e PaiU �u�—_3.p— <br /> Ealance Duo S C�i2��' <br /> Print or Type Only — — <br /> ��1�-,���s ��or�4.f�,� 7�,i ��EUE,e�s• %,�r- �E�r� y��j .�s�-a�sd"� ; <br /> Owner MailingAdd�ess City Zip Phone i <br /> C���A2c�s i"�onE�As�J I�� _ E��?y �.Au� �dt,e�» /��'ov3 d's3-o2�'�' � � <br /> Applicant Ma�ling Address City Zip Phone <br /> Describe Proposed Work yO�C_ � `��N ��� '�/ _ <br /> T— � <br /> s��<�—� ��rC-�'� Cl/L�OG�_�Si�'tC�S'/y� <br /> 7'� r=lyc'/f ii _c �SCi'.�l/.��/�iv <br /> � % G � � <br /> Project F,ddress G� knowN _���— . - � <br /> � <br /> Attach four�4) copies ol plans fo� proposr.d v�ork - Dr;3w to>ca'a an0 note the following as apPlicable: s �i <br /> • Property Lines • Centerline of sireet I <br /> • Outline and dimen,ions o�all exislir:g and • Indicale Norih ' I <br /> proposed struclures on the lot • Shc�.v any proposed gradin� changes I <br /> • Existing and propesed i.:ildies • Show s�easurements � I <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDIT:JNS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone�59•881 O. � <br /> 2.All work shall be pertormed in ac;.ordance w�th ihis permit and current City ol Everett Jes:.7n and Construction <br /> Standards and Specificatior•= <br /> 3.Call Lowiion Underground Service 48 hrs.before you d�g.TOLL PRHE NUMBER 1$fl0•424•5SS�i. . � <br /> � I <br /> ///� <br /> �_'„ , . i - ����L:I � ..._ � <br /> / � . <br /> �I���,J�5�i <br /> ' , I .I_ _�] � <br /> ., i ', J.I,��7 <br /> I <br /> �1CKNOWLEDGEMENT OF CONDITIONS �I <br /> The undersigned owne�/appGcaN hereby agrees to hold and save haim� <br /> — —� less the City of Everett from any and all claims for damage�, costs, � <br /> '�� � expenses. or causes ol action that may arise because of inslallation <br /> and rnaintenance of the improvement or other riqhPoh�vay use he:eto <br /> applied for and Icrther agrees to remove same upon notice irom the <br /> Appro e� lor onsir � n Date Ciry and t place public property maged ihereby. <br /> l ` � <br /> �� — /��. 1 <br /> FINAL INSPECTION Date <br /> P.pproved as Constructed Sic7na ure ol Applicant � Dale <br /> W�RK AUTHORIZED BY THIS P[RMIT MUST BG STARTED WITHIN <br /> everet[ PUBLICWORKSDEPAFTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar S�iee! BE DILIGENTLY PURSUED TO COMPLETION. �HIS PERMIT MAY BE <br /> Everett,WA 98201 GANCELLED 6'(THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br /> � <br /> � <br /> -- --- --._. _.-------- —'_' -- — "'�' <br />